When is my injury not covered by workers’ comp?

Workers’ compensation is a benefit provided to employees in Georgia which covers an employee in the case of an on-the-job accident. This coverage may include medical care, ongoing rehabilitation treatment, as well as supplemental wages in extreme circumstances. If you or a loved one have been injured in a workplace injury, it is important that you take the necessary steps to file a claim with the employer to receive benefits as soon as possible.

History of workers’ compensation

The concept of workers’ compensation correlates entirely to the development of negligence and tort law in English common law. The theory of contributory negligence and the “fellow servant rule” in the nineteenth century helped determine when an employer was liable for harm caused to a worker. In a contributory negligence claim, an employer would not be at fault if the worker’s actions contributed to the injury. Under the “fellow servant” rule, an employer was also not at fault if the injury was attributed to the actions of another employee. More recently, employees could be held under the common-law principle of “assumption of risk”, essentially providing that an employee who was aware of a dangerous work environment could not hold the employer responsible if an accident occurred.
While these legal principles were developed centuries ago, it was extremely expensive for a worker during this time to bring any claim against an employer. Most opted to not bring a claim at all given the great expense. However, some employees could succeed through tort legislation.
The first workers’ compensation law in the United States was passed in Wisconsin in 1911. Georgia followed a few years later with the first workers’ compensation law in the state in 1920. Prior to this time, the only way a worker could recover any type of compensation for injuries sustained as a result of a job accident was through a claim against the employer. This claim may not go in favor of the employee, so it was largely the result of specific circumstances. The workers’ compensation laws passed after 1920 provided workers with a method to recover after an on-the-job accident left them unable to work and provide for their families. Georgia enacted the Georgia State Board of Workmen’s Compensation to provide compensation to injured employees.
The most important piece of Georgie workers’ compensation is that it no longer requires employees to prove that the employer was responsible for the accident that resulted in the injury. As such, even an employee’s own actions in the accident could not be held against them in bringing a workers’ compensation action.

What is covered under workers’ compensation?

Workers’ compensation in Georgia covers employers who receive an injury while on the job. However, this does not mean that there must be an accident at the place of employment. While many claims do involve workplace accidents, other claims may involve injuries that come on gradually, such as infections, joint damage, heart attacks, or diseases caused by workplace environments.
The Georgia Workers’ Compensation Act defines “employee” as a person who is under the service of another under any contract of hire or apprenticeship. To qualify for workers’ compensation in Georgia, you must work for a company which provides workers’ compensation. Every business is required by Georgia law to provide workers’ compensation to their employees if they employee more than 3 workers. Even a regular part-time employee (such as one who works regular shifts) is eligible to take advantage of workers’ compensation.
However, the following classes of workers are not covered:

• Independent contractors
• S. government employees
• Railroad employees
• Farm laborers (however an employer of farm laborers may elect to provide coverage through giving notice to the state)

Officers of corporations may also elect to be exempt from workers’ compensation through filing a certificate with the insurer or the State Board of Workers’ Compensation.

What is considered a work-related injury?

Injuries covered under Georgia workers’ compensation must occur while the employee is actively engaged in their ongoing duties during employment. The “course of employment” does not only mean injuries caused during the 9-5 workday, but can also include employer-sponsored events that occur on the weekend, or accidents that occur while an employee is traveling to and from locations as part of their job.
Injuries under the Georgia Workers’ Compensation Act include:

• Broken bones
• Concussion
• Lacerations
• Hearing loss
• Lung damage from ongoing exposure to toxic fumes
• Arthritis caused by heavy lifting

In 1992, the Georgia legislature additionally developed a list of what was considered a “catastrophic” injury (subject to increased benefits in certain situations) which includes:

• Spinal cord injury leading to severe paralysis
• Amputation of arm, hand, foot, or leg (leading to the loss of use of that appendage)
• Severe brain injury (must be evidenced by sensory disturbances, communication disturbances, among others)
• Second or third degree burns over 25 percent of the body or third degree burns to 5 percent or more of the face or hands
• Total blindness
• Injuries leading to the inability to do sustain a job

Georgia workers’ compensation differentiates between catastrophic injuries and non-catastrophic injuries. In catastrophic injury cases, the Georgia State Board of Workers’ Compensation will focus on the ability of the employee to return to work after the accident, and will consider the following in their decision:

• Medical diagnosis over the past year
• Medical records
• Treating physician’s opinion
• Employee’s work history
• Employee’s education

What are examples of injuries not covered?

Injuries covered under Georgia workers’ compensation may not include anything related to an injury caused by a willful attack against a person for personal reasons, alcoholism, or heart disease.
Furthermore, if your employment status with your employer is that of an independent contractor, or if you are a farm laborer whose employer has not elected to provide workers’ compensation coverage, you will not be eligible to claim an injury. It is important that you carefully research your rights and your employer’s obligations and consult with an experienced professional during this time.

What is employee partially at fault?

While decades ago, an employee was required to prove that the employer was at fault for any resulting injuries that occurred on the job, employees currently do not have this requirement when filing a claim.

Are repetitive motion injuries and stress injuries covered?

Injuries covered by workers’ compensation may include a disease which evolved from an accident that occurred during employment. Injuries may also include an aggravation of a preexisting condition caused by an accident during employment. Injuries caused by ongoing stress injuries will be covered by workers’ compensation. These injuries may include:

• Arthritis from ongoing heavy lifting
• Carpal tunnel
• Knee or joint damage

However, the employee will need to keep careful medical records and be able to show that the injury was caused by their work environment and ongoing job duties.

What is an occupational illness?

Occupational illnesses may occur after prolonged exposure to hazardous chemicals. Your employer has a duty to protect its employees from dangerous situations, and the result of ongoing exposure leading to illness will qualify as a workplace injury. Toxins may include:

• Asbestos
• Mold
• Chemicals

An employee is eligible to claim the cost of their occupational illness even if symptoms occur years after the initial exposure.

What Can We Do For You?

The procedural requirements for filing a workers’ compensation action may seem overwhelming immediately after a devastating accident impacts your ability to work. The legal team of Kaufman Law, P.C. has experience in assisting clients with their workers’ compensation claims, and determining whether any individual injuries should be brought outside the Georgia State Board of Workers’ Compensation. Our team will take the burden of dealing with the administrative headache from you, while you focus on recovering from your injury. Contact our Atlanta office today for your initial free consultation.